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Mission Statement (and disclaimer)

* To inform, educate, inspire colleagues and general public by sharing my own experiences, observations, thoughts, and insights drawn from my life and career in medicine and surgery.

* To explore my life and surgical career, as my journey progresses.

* To pose questions, address controversies, frame debate and discussion about/around topics, events, and issues that touch medicine and surgery, and the physicians and surgeons, institutions, and people involved and affected.

This will mainly be framed in the context of personal essays, discussions, conversations, observations (albeit one-sided).

I speak only for myself, the thoughts and opinions are mine; if I quote or borrow from others, appropriate attribution will be made.The educational and other institutions, groups, and organizations I have been and continue to be involved with have not sanctioned or approved the content, my comments here should not and do not reflect their opinions or represent them in any way. Likewise, I do not deign to represent my peers and colleagues. With that said, I hope that I respect and honor them all here in this place.

Posts and the information shared should not be taken as medical or treatment advice; any concerns or problems should be discussed and evaluated with your own physician or health care provider.

Comments are welcome, but will be reviewed and approved before posting.

Spring Hopes Eternal: Spring in the Time of Coronavirus

Spring is in the air. It is gradually awakening, even in this little corner of the Northeast, where it is historically slow to emerge. Signs of spring are all around. It’s in the dawn birdsong that doesn’t gently stir awake, but insists on bursting into a raucous celebration of the new day. It’s in the early-blooming flowers that infuse hints and patches of color into the drab grey-brown landscape of the fading winter. The daffodils are blooming now, and the forsythia too, in sunny bright yellow shades that dare you to try not to be happy. It is a typical coastal New England spring.

This spring feels different. There is a cloud shrouding this spring, heavier and more persistent than the fleeting clouds and fog of a typically capricious New England spring, with its March bluster and April showers. This is the cloud of the new SARS-CoV-2 coronavirus and its attendant illness COVID-19, spreading globally and around the country, even to this little corner of coastal New England. It has seemed colder, cloudier, and rainier this spring, probably because those are the days that reflect the mood. The sunny days seem like a betrayal, incongruous with this cloud of disruption, fear, pain and grief. This spring is not typical.

This cloud has darkened the mood of every physician I know. It has been a long time since we physicians have felt like this, helpless in our ministrations, and also so personally vulnerable. We are no strangers to deadly diseases, illnesses, injuries, or even personal risk in the service of our patients and communities. Sacrifice and risk are woven into the fabric of our professional mantle. We have seen HIV/AIDS, and other deadly infectious diseases, cancers and gun violence, and with all of these we prepare and brace and face them each head-on. We walk towards disasters, we don’t shy away. It is simply what we do.

COVID-19 is different, and it is devastating. It is easily transmitted, and can spread sneakily, before symptoms appear and after symptoms resolve, making it difficult if not impossible to contain. The symptoms themselves can be subtle, and can quickly and unpredictably escalate to their most severe and lethal expression. We think we know who are the most vulnerable–the elderly and those with pre-existing medical conditions– but then we watch healthy and vigorous people succumb to the disease. Physicians are at especially high risk of getting the illness, with greater severity, and graver outcomes. It is a cruel irony that we physicians are a more vulnerable group than those we treat. Couple this with considerable limitations on our ability to protect ourselves, and it is no wonder that doctors are afraid.

Doctors feel so vulnerable because they feel so powerless and exposed with COVID-19. We lack adequate personal protective equipment (PPE), we don’t have enough supportive equipment (ventilators, ECMO), and medications are running out. All we have are the most ancient of tools–the hygiene of hand washing, and physical distancing/quarantine. Tools that we need every individual and our entire communities to employ for them to work, not only for themselves, but also to protect doctors and healthcare workers. These tools buy us time. Time we need to slow the onslaught of patients and flatten the curve. We need the time to find some treatments that work. Without tools, and time, we are too easily overwhelmed and incapacitated, incapable of providing any care to anybody. When that happens, the entire system collapses.

All we can do is nothing. Nothing is a very hard thing to do. Stay home. Stay alone, isolate. Even at the hospital, all we can do is support the patients. There are no preventions, no prophylaxis, no vaccine, no medications, no treatments, no procedures, no cures. Our only treatment is supportive, until it isn’t. COVID-19 runs its course and COVID-19 dictates what happens, in ways we don’t yet fully understand. We celebrate the victories as individual people recover, we mourn the losses, and in our hearts we know we can neither accept credit nor blame for either outcome.

The apprehension, fear, dread, and anxiety are palpable in my colleagues as I have never seen before. It has never felt so profoundly visceral to me in my entire professional lifetime, even in the days of HIV/AIDS. I can see it on their faces, hear it in their words, read it in what they write. It marks everybody–from those who are working the front lines, to those whose practices are suspended. There are those who have been sidelined, trying to reconcile relief and guilt for not being exposed at work. Those who anticipate work outside of their expertise with anxiety as they try to recall old skills and knowledge. There is the anticipation of the inevitable surge, like a tsunami wave, where the virus hasn’t yet taken hold. For the first time we feel a profound dread in answering our calling. Yet still we answer, each in our own way.

There is fear at work, of becoming infected, or infecting patients or colleagues. There is fear at home, potentially sickening families and loved ones. Young physicians are making wills, and making wishes known. If exposed, there is the stress of not knowing what to expect — will I be sick? How sick? Will I need the hospital, the ventilator? Will I die? Then the same litany of questions repeats, only about family members, every time you come home. There are doctors who don’t come home at all, to spare exposing their families. As a result, these doctors must bear all of this in even more isolation, without the balm of their usual sources of comfort and solace. There is uncertainty imagining what happens next. Who, and what, will survive. What will become the new normal, and when? Will things ever get back to usual?

There are no more usual days. This is not a usual spring. But all of the usual signs of spring persist and progress, oblivious to this COVID-19 pandemic cloud. Spring insists on pursuing its mission. Spring insinuates itself and its message into our thoughts, every time we take a break and look around and take notice.

So spring comes as it always does, even if doesn’t seem like a usual spring. Nothing stops time and the seasons. Spring is the season of awakening, of rebirth, of hope. This is the biologic imperative of spring, changing the earth itself, the flora and fauna. It is echoed in our culture and our faith traditions. When the sunlight breaks through the clouds to reveal a glorious day, and you feel the warmth of the rays on your face gently nudging away the chilly air, you can almost hear the whisper in your ear, “Hope.”

As I think about the fears clouding this spring, I remember the spring of my first year of medical school. Then, the biggest trials and tribulations involved our studies and exams. That spring in D.C., a city known for its spectacular springtime display, we had a notoriously difficult class with even more notoriously difficult exams. No one did well. Ever. That is when I thought up my mantra, “The sun will still shine, the birds will still sing, and my mother will still love me… (even if I fail the exam)” It helped. Recalling this mantra carried me through many difficult times. Even now the sounds of spring birdsong pierce my gloom and remind me of those words. I have not been as sure of their promise of comfort lately, but then I glimpse early spring flowers out of the corner of my eye.

Spring is still coming, it will always come. It brings with it hope, it always does. Every blade of grass, every leaf, every flower is proof. Every sound from the spring peepers, the birds singing, the animals calling is testimony. Spring reminds us, no matter how dark the mood and challenging the times, that it is all right to hold on to hope and joy. We can embrace this comfort to dampen our dread and fears. Spring explicitly shows us that life goes on, and we can use that to hope, to help us believe that we will, too.

So, hold on to these hopeful comforting words, to remember there is still sun shining, there are still birds singing, and there is still love. Even now, and especially now. Let them remind us that we can do this, we can get through this. We can figure this all out, eventually. There will be a new normal, and we will adjust as it evolves into the new usual. We will again have a usual spring.